医学最新文献

Objectives: Cardiac surgery using cardiopulmonary bypass (CPB) induces a systemic inflammatory response that affects common inflammatory markers, including C-reactive protein (CRP), white blood cell count (WBC), and body temperature, complicating postoperative diagnosis of infections. The objective of this study was to assess the incidence of postoperative infections and evaluate the performance of clinically used biomarkers.

Design: This was a bidirectional cohort study including patients undergoing cardiac surgery with CPB between 1st of February 2020 and 22nd of September 2021. Patients with postoperative infection were compared to patients without. Multivariable logistic regression was used to identify independent predictors of postoperative infections. Receiver operating characteristic (ROC) curves evaluated the diagnostic ability of current biomarkers to detect infection.

Results: A total of 1,222 patients were included. The incidence of postoperative infections (during hospitalisation and/or late infection) was 17.3%. Patients with postoperative infection had more comorbidities, underwent more complex procedures, and had higher mortality (90-day mortality 3.8% vs 1.5%, p = 0.045; 1-year mortality 5.7% vs 2.7%, p = 0.032). CRP, WBC, and temperature performed poorly in detecting postoperative infection, although peak CRP (OR 1.069, p < 0.001) and peak temperature (OR 2.408, p = 0.005) were independent predictors of postoperative infection. Peak temperature occurred on postoperative day 5 in infected patients versus day 2 in those without infection.

Conclusion: Postoperative infections following cardiac surgery with CPB remain common and are associated with increased postoperative complications and mortality. Common inflammatory biomarkers perform poorly in detecting infection. Improved diagnostic tools are needed to facilitate early detection and treatment.

Based on a synthesis of recent advances, this review elucidates the distinct yet synergistic roles of non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in memory consolidation. During NREM sleep, cortical slow oscillations (SOs) establish a temporal framework by alternating between UP and DOWN states, facilitating cross-regional communication. SOs phase-couple with thalamic spindles to coordinate hippocampal sharp-wave ripples (SWRs), thereby driving the reactivation and transfer of labile hippocampal memories to neocortical networks for long-term storage. Concurrent synaptic homeostasis optimises network efficiency through global downscaling while selectively strengthening memory-relevant connections. In REM sleep, theta oscillations synchronise limbic-prefrontal-hippocampal circuits, and ponto-geniculo-occipital (PGO) waves further integrate emotional and procedural memories. The cholinergically dominant, monoamine-depleted neurochemical milieu of REM sleep promotes dendritic spine remodelling and sparse neuronal reactivation, enabling affective decoupling and synaptic refinement. Despite progress, key challenges remain in understanding cross-frequency oscillatory coupling among slow oscillations, spindles, ripples and REM-specific rhythms, glial contributions and clinical translation. Future integration of high-density electrophysiology with computational approaches may yield mechanistic models and clinically relevant biomarkers for sleep-based cognitive monitoring and intervention.

This retrospective single-centre observational study included 262 sequential patients with acute coronary syndromes (ACS) undergoing invasive coronary angiography (ICA) while receiving P2Y₁₂ inhibitors and considered for coronary artery bypass graft surgery (CABG); P2Y₁₂ inhibitors (ticagrelor 91%, thienopyridine 9%) were stopped prior to CABG. The primary outcome was recurrent myocardial infarction or death following ICA and prior to revascularisation or decision for conservative management. 2 patients (0.8%) had recurrent MI and died following ICA and prior to planned CABG, demonstrating a small risk of MI and death in patients who have delays to CABG following ICA for ACS.

Purpose: Clinical features of COPD and asthma overlap, complicating differential diagnosis. This study investigated the prevalence of comorbid asthma in COPD patients and its association with patient-related outcomes.

Materials and methods: Patients with a doctor's diagnosis of COPD were randomly selected in two cohorts 2005 (n = 1060) and 2014 (n = 1671), from primary and secondary care in Sweden. Data were collected from medical records and patient questionnaires at baseline and at follow-up (2012 and 2022, respectively). Questionnaires included data on exacerbations. Symptoms were assessed using the clinical COPD questionnaire (CCQ). Comorbid asthma was identified through medical records. Ten-year mortality data were obtained from national registers. Logistic and linear regression assessed associations with patient-reported outcomes; Cox regression was applied for mortality analyses.

Results: Comorbid asthma was found in 22% of the 2005 cohort and 9% of the 2014 cohort (p < .001). In both cohorts, it was associated with an increased risk of exacerbations: OR (95% CI) 1.58 (1.07-2.32), p = .02, and 2.20 (1.38-3.52), p < .001, respectively. No associations were found between comorbid asthma and worsening of health status (CCQ). Mortality risk did not differ in the 2005 cohort, HR (95% CI) 0.92 (0.71-1.18), but was lower in the 2014 cohort, HR (95% CI) 0.67 (0.49-0.93), p = .02.

Conclusion: Comorbid asthma in COPD has changed from 22 to 9%, potentially due to improved diagnostics. Comorbid asthma remains clinically relevant due to its association with an increased exacerbation risk.

Significance: Deep learning (DL)-based image reconstruction methods for photoacoustic computed tomography (PACT) have developed rapidly in recent years. However, most existing methods have not employed standardized datasets, and their evaluations rely on traditional image quality (IQ) metrics that may lack clinical relevance. The absence of a standardized framework for clinically meaningful IQ assessment hinders fair comparison and raises concerns about the reproducibility and reliability of reported advancements in PACT.

Aim: A benchmarking framework is proposed that provides open-source, anatomically plausible synthetic datasets and evaluation strategies for DL-based acoustic inversion methods in PACT.

Approach: The datasets each include over 10,000 two-dimensional (2D) stochastic breast objects with clinically relevant lesions and paired measurements at varying modeling complexity. The evaluation strategies incorporate both traditional and task-based IQ measures to assess fidelity and clinical utility. A preliminary benchmarking study is conducted to demonstrate the framework's utility by comparing DL-based and physics-based reconstruction methods.

Results: The benchmarking study demonstrated that the proposed framework enabled comprehensive, quantitative comparisons of reconstruction performance and revealed important limitations in certain DL-based methods. Although they performed well according to traditional IQ measures, they often failed to accurately recover lesions. This highlights the inadequacy of traditional metrics and motivates the need for task-based assessments.

Conclusions: The proposed benchmarking framework enables systematic comparisons of DL-based acoustic inversion methods for 2D PACT. By integrating clinically relevant synthetic datasets with rigorous evaluation protocols, it enables reproducible, objective assessments and facilitates method development and system optimization in PACT.

Significance: Thyroid nodules have a high incidence, but a low malignancy rate, placing demands on imaging specificity. Photoacoustic imaging is being studied as a method that could potentially help increase the unsatisfactory specificity of ultrasound, the current first-line imaging method, which would decrease the number of unnecessary clinical interventions.

Aim: We employ a digital thyroid phantom and numerical simulations to evaluate photoacoustic probe designs on their suitability for thyroid nodule risk estimation.

Approach: Using the SIMPA toolkit, we examined 1080 probe configurations with varying illumination geometry, detector shape, pitch, and wavelength combinations. The performance of each probe was quantified on its sensitivity and its accuracy of oxygen saturation estimation.

Results: Optimal performance was found using wavelengths 757 and 800 nm, and a curved detector (0.5 split, 0.40 mm pitch) for external illumination. However, performance increases significantly with endotracheal illumination, using wavelengths of 700 and 800 nm, and a curved detector (0.25 split, 0.40 mm pitch).

Conclusions: These results could provide design guidance for optimizing photoacoustic hardware, assisting with the clinical adoption of PAI, which could improve the diagnosis of thyroid nodules.

Women's autonomy in fertility decision-making is essential for improved health and social outcomes. Guided by the social-ecological model, this investigation explores multilevel influences on the fertility autonomy of women with an unmet need for family planning in rural Uganda. We conducted four focus groups with men and women (n = 26), and 15 key informant interviews with community leaders and individuals involved in the provision of family planning. The data were analyzed thematically. The results highlight how community-level norms reinforce gender inequalities in decision-making and underpin beliefs to not limit men's number of children. Religious norms and polygamy practices were shown to influence attitudes towards family size and family planning, as well as shape relationship dynamics related to fertility. Concerns about poverty were identified as a driver of shifting preferences and increasing acceptance of family planning. Results showcase how health system weaknesses limit women's access to family planning services, contribute to mistrust of health systems and drive misinformation about contraceptives, especially among men. This study underscores the need for multifaceted gender transformative interventions to increase women's fertility autonomy. This study also highlights health system strengthening, religious leader endorsement and male engagement as approaches to increase women's autonomous use of family planning.